YMCA Kitchener-Waterloo Donation Form

DONATION FORM
Please use this online form to make your secure, charitable donation. An electronic charitable tax receipt will be sent to the email address you provide.

* denotes required information

Make a personal donation:
Make your donation on behalf of an organization:

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* First Name:
* Last Name:

* Organization:

Contact Information


	Home Work

Enter address manually
* Address:

* City/Town:
* Country:
* * * Province/State:
* Postal/Zip Code:
Phone Number:	( ) Ext.
Cell Phone Number:	( )
* Email Address:

Allow The YMCA to contact me by email.
I give The YMCA permission to contact me by mail (post).

Survey Questions

Please direct my gift to the following:

Is there a special reason for your gift today?

* Is this donation in honour or in memory of someone?

* May the YMCA acknowledge your donation in any public recognition?

Yes
No, I wish to remain anonymous

I wish to be recognized with the following name(s):

Please specify the name of the person you are donating in honour or memory of

Gift Designation

Payment Information

Pay using Credit Card
Card Security Number is not supported in data entry. To process a credit card payment, you need to disable Card Security from the Electronic Payment page in the Configuration tab.
Payment Method:
* * Donation Amount:
* Processing Date:
* Number of Installments:
	installments
Pay using PayPal
* Credit Card Type:
* Credit Card Number:
* Card Security Number:	Where is my Card Security Number?
* Cardholder's Name:
* Credit Card Expiration:
Card Valid From
Issue Number

* Bank Name:
* Bank ID:
* Cheque Number:
* Transit number:
* Account Number:

Security Check

We have implemented an extra step in order to prevent Credit Card fraud. Unfortunately, some people use automated programs to test whether fraudulently obtained credit cards are valid. To counteract this practice we ask that you answer the question below.

DONATION FORMPlease use this online form to make your secure, charitable donation. An electronic charitable tax receipt will be sent to the email address you provide.

Contact Information

Survey Questions

Payment Information

DONATION FORM
Please use this online form to make your secure, charitable donation. An electronic charitable tax receipt will be sent to the email address you provide.